{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:42:35Z","timestamp":1786117355934,"version":"build-2736575974"},"reference-count":24,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009243","name":"Direction G\u00e9n\u00e9rale de l\u2019offre de Soins","doi-asserted-by":"publisher","award":["PREPS-22-0065"],"award-info":[{"award-number":["PREPS-22-0065"]}],"id":[{"id":"10.13039\/501100009243","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,22]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Primary liver cancers, including hepatocellular carcinoma and intrahepatic cholangiocarcinoma, are one of the leading causes of cancer-related mortality. Transarterial chemoembolisation (TACE) and radioembolisation (TARE) are established palliative treatments yet they are traditionally performed during inpatient hospitalisation. Recent technical and organisational advances allow for safe same-day ambulatory procedures. In particular, the extent to which ambulatory intra-arterial therapy aligns with patients\u2019 expectations, comfort and quality of life remains poorly documented. The Care pathway for Hepatic intra-arterial Oncology in an ambulatory Context study (CHOC) trial aims to evaluate the implementation and effectiveness from both patient-centred and clinical perspectives of an ambulatory care pathway for intra-arterial treatment of primary liver cancer in a multicentre randomised hybrid type 1 trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>CHOC is a pragmatic, multicentre, randomised controlled hybrid type 1 trial comparing ambulatory versus conventional inpatient care for patients undergoing TACE or TARE for primary liver cancer. A total of 206 patients (103 per arm) will be randomised 1:1 and followed for 7 months. The primary outcome is the patient\u2019s global satisfaction score, measured 3\u2009days post-procedure using the EORTC PATSAT-C33 questionnaire. Secondary outcomes include quality of life, safety, clinical outcomes, cost analysis and an embedded qualitative implementation study assessing acceptability, adoption, feasibility and sustainability across centres. Economic analyses will estimate both per-patient costs and the 5-year budget impact for the French national health insurance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study has received ethical approval from the Protection of Persons Committee and adheres to the Declaration of Helsinki, good clinical practice and French regulatory requirements. Findings will be disseminated through peer-reviewed publications, conferences and participating centres to guide broader implementation of ambulatory interventional radiology care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06990659\">NCT06990659<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114720","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:40:18Z","timestamp":1786023618000},"page":"e114720","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation and evaluation of an ambulatory care pathway for intra-arterial treatment of primary liver cancer: study protocol for a multicentre randomised controlled hybrid type 1 trial (CHOC)"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06990659","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06990659","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06990659","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6081-1663","authenticated-orcid":false,"given":"Jules","family":"Gr\u00e9gory","sequence":"first","affiliation":[{"name":"Department of Radiology, CRI Inserm 1149, Universit\u00e9 Paris Cit\u00e9, FHU MOSAIC\u00b2, AP-HP H\u00f4pital Beaujon, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Fran\u00e7ois","family":"Hammel","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Biostatistique, CHU Angers, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Ronot","sequence":"additional","affiliation":[{"name":"Department of Radiology, CRI Inserm 1149, Universit\u00e9 Paris Cit\u00e9, FHU MOSAIC\u00b2, AP-HP H\u00f4pital Beaujon, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Roux","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, AP-HP H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Barat","sequence":"additional","affiliation":[{"name":"Department of Radiology, AP-HP H\u00f4pital Cochin, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manon","family":"Allaire","sequence":"additional","affiliation":[{"name":"Department of Hepatology, AP-HP H\u00f4pital Piti\u00e9-Salp\u00eatri\u00e8re, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Parlati","sequence":"additional","affiliation":[{"name":"Department of Hepatology, AP-HP H\u00f4pital Cochin, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Moussa","sequence":"additional","affiliation":[{"name":"Department of Radiology, CHD Vend\u00e9e, La Roche-sur-Yon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Beunon","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, Institut Gustave-Roussy, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Oberti","sequence":"additional","affiliation":[{"name":"Department of Hepatology, CHU Angers, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Chevallier","sequence":"additional","affiliation":[{"name":"Department of Radiology, CHU Nice, Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolphe","family":"Anty","sequence":"additional","affiliation":[{"name":"Department of Hepatology, CHU Nice, Nice, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Girot","sequence":"additional","affiliation":[{"name":"Department of Hepatology, CHD Vend\u00e9e, La Roche-sur-Yon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Sutter","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, AP-HP CHU Avicenne, Bobigny, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Ganne","sequence":"additional","affiliation":[{"name":"Department of Hepatology, AP-HP CHU Avicenne, Bobigny, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panteleimon","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Department of Digestive and Interventional Imaging, CHU Bordeaux, Pessac, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Fr\u00e9d\u00e9ric","family":"Blanc","sequence":"additional","affiliation":[{"name":"Department of Hepatology, CHU Bordeaux, Talence, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Ghelfi","sequence":"additional","affiliation":[{"name":"Department of Radiology, CHU Grenoble Alpes, La Tronche, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Decaens","sequence":"additional","affiliation":[{"name":"Department of Hepatology, CHU Grenoble Alpes, Grenoble, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thierry","family":"Yzet","sequence":"additional","affiliation":[{"name":"Department of Radiology, CHU Amiens, Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Nguyen-Khac","sequence":"additional","affiliation":[{"name":"Department of Hepatology, CHU Amiens, Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beno\u00eet","family":"Magnin","sequence":"additional","affiliation":[{"name":"Department of Radiology, CHU Clermont-Ferrand, Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00e9on","family":"Muti","sequence":"additional","affiliation":[{"name":"Department of Digestive and Hepatobiliary Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Romain","family":"Risson","sequence":"additional","affiliation":[{"name":"Department of Radiology, CHU Brest, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Tann","sequence":"additional","affiliation":[{"name":"Department of Hepatology, CHU Brest, Brest, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Boige","sequence":"additional","affiliation":[{"name":"Department of Oncology, Institut Gustave-Roussy, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Calame","sequence":"additional","affiliation":[{"name":"Department of Radiology, CHU Besan\u00e7on, Besan\u00e7on, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carine","family":"Richou","sequence":"additional","affiliation":[{"name":"Department of Hepatology, CHU Besan\u00e7on, Besan\u00e7on, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Val\u00e9rie","family":"Vilgrain","sequence":"additional","affiliation":[{"name":"Department of Radiology, CRI Inserm 1149, Universit\u00e9 Paris Cit\u00e9, FHU MOSAIC\u00b2, AP-HP H\u00f4pital Beaujon, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre-Emmanuel","family":"Rautou","sequence":"additional","affiliation":[{"name":"Department of Hepatology, AP-HP H\u00f4pital Beaujon, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Darsonval","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Angers University Hospital, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Nhora","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, ECEVE, INSERM UMR 1123, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Devictor","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, ECEVE, INSERM UMR 1123, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Bouattour","sequence":"additional","affiliation":[{"name":"Liver Cancer and Innovative Therapy Unit, AP-HP H\u00f4pital Beaujon, Clichy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuelle","family":"Cartron","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9, ECEVE, INSERM UMR 1123, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Aub\u00e9","sequence":"additional","affiliation":[{"name":"CHU Angers, Department of Radiology, Laboratoire HIFIH UPRES 3859, SFR ICAT 4208, Angers University, Angers, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"2026080606401146000_16.8.e114720.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2024.08.028"},{"key":"2026080606401146000_16.8.e114720.2","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/HEP.0000000000000544","article-title":"Chemotherapy with or without selective internal radiation therapy for intrahepatic cholangiocarcinoma: Data from clinical trials","volume":"79","author":"Edeline","year":"2024","journal-title":"Hepatology"},{"key":"2026080606401146000_16.8.e114720.3","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.jvir.2017.08.024","article-title":"Transradial Versus Transfemoral Arterial Access in Liver Cancer Embolization: Randomized Trial to Assess Patient Satisfaction","volume":"29","author":"Yamada","year":"2018","journal-title":"J Vasc Interv Radiol"},{"key":"2026080606401146000_16.8.e114720.4","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1016\/j.jvir.2017.06.022","article-title":"Transradial versus Transfemoral Access for Hepatic Chemoembolization: Intrapatient Prospective Single-Center Study","volume":"28","author":"Iezzi","year":"2017","journal-title":"J Vasc Interv Radiol"},{"key":"2026080606401146000_16.8.e114720.5","doi-asserted-by":"crossref","DOI":"10.1097\/HC9.0000000000000252","article-title":"Prediction of postembolization syndrome after transarterial chemoembolization of hepatocellular carcinoma and its impact on prognosis","volume":"7","author":"Roehlen","year":"2023","journal-title":"Hepatol Commun"},{"key":"2026080606401146000_16.8.e114720.6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.diii.2022.10.013","article-title":"Improving pain control during transarterial chemoembolization for hepatocellular carcinoma performed under local anesthesia with multimodal analgesia","volume":"104","author":"Vanderbecq","year":"2023","journal-title":"Diagn Interv Imaging"},{"key":"2026080606401146000_16.8.e114720.7","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00259-022-06002-5","article-title":"Defining textbook outcome for selective internal radiation therapy of hepatocellular carcinoma: an international expert study","volume":"50","author":"Gregory","year":"2023","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2026080606401146000_16.8.e114720.8","doi-asserted-by":"crossref","first-page":"2353","DOI":"10.1007\/s00259-016-3438-x","article-title":"Same-day 90Y radioembolization: implementing a new treatment paradigm","volume":"43","author":"Gabr","year":"2016","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2026080606401146000_16.8.e114720.9","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.jvir.2008.10.027","article-title":"Safety and feasibility of outpatient transcatheter hepatic arterial embolization for hepatocellular carcinoma","volume":"20","author":"Mitchell","year":"2009","journal-title":"J Vasc Interv Radiol"},{"key":"2026080606401146000_16.8.e114720.10","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1007\/s00270-023-03578-9","article-title":"French Interventional Radiology Centers\u2019 Uptake of Transradial Approach and Outpatient Hepatocellular Carcinoma Intra-Arterial Treatments","volume":"47","author":"Gr\u00e9gory","year":"2024","journal-title":"Cardiovasc Intervent Radiol"},{"key":"2026080606401146000_16.8.e114720.11","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3182408812"},{"key":"2026080606401146000_16.8.e114720.12","article-title":"Implementation research: what it is and how to do it","volume":"347","author":"Peters","year":"2013","journal-title":"BMJ"},{"key":"2026080606401146000_16.8.e114720.13","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1001\/jamainternmed.2016.5974","article-title":"Alternative Strategies to Inpatient Hospitalization for Acute Medical Conditions: A Systematic Review","volume":"176","author":"Conley","year":"2016","journal-title":"JAMA Intern Med"},{"key":"2026080606401146000_16.8.e114720.14","unstructured":"A. HAS . Ensemble pour le d\u00e9veloppement de la chirurgie ambulatoire recommandations organisationnelles. In: Outils et Guides Interdiag Chir Ambu Outil de Diagnostic Interne de Chirurgie Ambulatoire. HAS, ANAP, Saint-Denis, Paris, 2013."},{"key":"2026080606401146000_16.8.e114720.15","doi-asserted-by":"crossref","unstructured":"Br\u00e9dart A , Anota A , Young T , et al . Phase III study of the European Organisation for Research and Treatment of Cancer satisfaction with cancer care core questionnaire (EORTC PATSAT-C33) and specific complementary outpatient module (EORTC OUT-PATSAT7). Eur J Cancer Care (Engl) 2018;27. doi:10.1111\/ecc.12786","DOI":"10.1111\/ecc.12786"},{"key":"2026080606401146000_16.8.e114720.16","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1097\/NCC.0000000000000302","article-title":"Management of Postembolization Syndrome Following Hepatic Transarterial Chemoembolization for Primary or Metastatic Liver Cancer","volume":"39","author":"Blackburn","year":"2016","journal-title":"Cancer Nurs"},{"key":"2026080606401146000_16.8.e114720.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-025-15119-3","article-title":"Phase IV international prospective validation of the EORTC patient satisfaction core questionnaire (EORTC PATSAT-C33) and outpatient module (EORTC OUT-PATSAT7)","volume":"25","author":"Br\u00e9dart","year":"2025","journal-title":"BMC Cancer"},{"key":"2026080606401146000_16.8.e114720.18","doi-asserted-by":"crossref","unstructured":"Cohen J . Statistical power analysis for the behavioral sciences. 2nd edn. New York: Routledge, 2013.","DOI":"10.4324\/9780203771587"},{"key":"2026080606401146000_16.8.e114720.19","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1177\/2515245919847202","article-title":"Evaluating Effect Size in Psychological Research: Sense and Nonsense","volume":"2","author":"Funder","year":"2019","journal-title":"Advances in Methods and Practices in Psychological Science"},{"key":"2026080606401146000_16.8.e114720.20","unstructured":"Cohen J . Statistical power analysis for the behavioral sciences. 2nd edn. Hillsdale, NJ: L. Erlbaum Associates, 1988."},{"key":"2026080606401146000_16.8.e114720.21","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.007984"},{"key":"2026080606401146000_16.8.e114720.22","unstructured":"Paill\u00e9 P , Mucchielli A . Chapitre 11 - l\u2019analyse th\u00e9matique. Collection U, 2012: 231\u2013314."},{"key":"2026080606401146000_16.8.e114720.23","unstructured":"Haute Autorit\u00e9 de Sant\u00e9 . Choix m\u00e9thodologiques pour l\u2019\u00e9valuation \u00e9conomique \u00e0 la HAS, Available: https:\/\/www.has-sante.fr\/jcms\/r_1499251\/fr\/choix-methodologiques-pour-l-evaluation-economique-a-la-has [Accessed 5 Mar 2026]."},{"key":"2026080606401146000_16.8.e114720.24","unstructured":"Haute Autorit\u00e9 de Sant\u00e9 . Choix m\u00e9thodologiques pour l\u2019analyse de l\u2019impact budg\u00e9taire \u00e0 la HAS, Available: https:\/\/www.has-sante.fr\/jcms\/c_2730306\/fr\/choix-methodologiques-pour-l-analyse-de-l-impact-budgetaire-a-la-has [Accessed 5 Mar 2026]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-114720","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:40:25Z","timestamp":1786023625000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-114720"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,6]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjopen-2025-114720"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-114720","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}